Improved Survival and Local Control After Intraoperative Radiation Therapy and Postoperative Radiotherapy

Abstract

Hypothesis: Despite aggressive approaches, locoregional tumor control and survival rates for patients with cancer of the pancreatic head remain disappointing. In the present study, we address whether intraoperative and adjuvant radiotherapy may improve the prognosis for these patients.

Treatment of Locally Advanced Pancreatic Ductal Adenocarcinoma

“…Previous publications from the Massachusetts General Hospital have found favorable oncologic and survival outcomes in select patients with unresectable pancreatic cancer [50,51]. Data on the use of IORT as an adjunct to surgical resection for LA-PDAC is inconclusive, with the majority of studies suggesting no survival benefit [52,53,54,55]. A more recent Japanese study of 210 patients treated with resection and IORT, in conjunction with chemotherapy and/or external beam radiation, resulted in 2-year local control rates of 87.1 and 74.6% following R0 and R1 resections, respectively [56].…”

Does Intraoperative Radiation Therapy Improve Local Tumor Control in Patients Undergoing Pancreaticoduodenectomy for Pancreatic Adenocarcinoma? A Propensity Score Analysis

“…24,25 Prior retrospective, single-institution reports suggest that IORT improves local control after PD by approximately 30%. 19,21 In this study, LRR was 50% less in the IORT group. In the prospective, randomized trial conducted at the NCI, local control improved from 0% to 33% with the addition of IORT.…”

“…[11][12][13][14][15][16][17][18][19] Although a definitive survival benefit has not been observed, improvement of local control by IORT at the time of PD for resectable pancreatic cancer is supported by retrospective data, as well as by a prospective, randomized trial conducted at the National Cancer Institute (NCI). [19][20][21] At our institution, IORT has been offered since 1986 in a dedicated operating suite located in the radiotherapy department for patients with either resectable or unresectable pancreatic cancer. IORT was considered for all patients undergoing PD at our institution until 1998.…”

Final Results of a Prospective Trial of a PEFG (Cisplatin, Epirubicin, 5-Fluorouracil, Gemcitabine) Regimen Followed by Radiotherapy after Curative Surgery for Pancreatic Adenocarcinoma

“…Several nonrandomized prospective experiences of postoperative management with either RT alone [16, 17, 20, 22, 25, 26, 27], or RT concomitant to 5-FU, both as a bolus [16, 20, 22, 23, 24, 25, 26]and as protracted venous infusion [28], or RT concomitant to gemcitabine [29], or RT concomitant to a three-drug therapy [30]have been reported (table 3). Actuarial 2-year OS from these series ranged between 20 and 64%.…”